The India Cable: World Takes India’s Crisis As Warning; SC Suggests Compulsory Licensing

New cases over 3 lakh for ninth day running, Jagan reveals credible vaccination timeline, pandemic essentials heavily taxed, Soli Sorabjee dies, and health minister says oxygen was, is and will be

From the founding editors of The Wire—MK Venu, Siddharth Varadarajan and Sidharth Bhatia—and journalists-writers Seema Chishti, Sushant Singh and Tanweer Alam. Editor: Pratik Kanjilal

Snapshot of the day

April 30, 2021

Pratik Kanjilal

In some locations in Delhi, it’s raining ashes.

“We are watching with total disbelief … What is happening in India cannot be ignored by our continent,” John Nkengasong, head of the Africa Centres for Disease Control and Prevention, has warned. He urged Africans to wear masks and avoid large gatherings, warning: “We cannot and should not find ourselves in [India’s] scenario because of the very fragile nature of our health systems.” India has had another record single-day rise of 3,86,452 new coronavirus infections and 3,498 deaths, as per the official data of the Health Ministry. The total number of deaths is now 2,08,330. This is the ninth straight day of over three lakh new cases in the country.

Jesse B. Bump, Executive Director of the Takemi Program in International Health and Lecturer on Global Health Policy in the Department of Global Health and Population at the Harvard TH Chan School of Public Health, wrote yesterday to his colleagues and students that Harvard Public Health School alumni “are reporting absolute disaster in India. Reality more dire than seen on the news. Entire families, buildings, communities infected. No oxygen, medicines, supplies, beds, or even storage for bodies. All linked to a cruel political gambit.”

India ranks 102nd in the world for genetic sequencing, as it is examining only 0.06% of its more than 300,000 daily coronavirus cases for genetic changes. This means that public health experts cannot yet determine how much the huge outbreak is being driven by highly transmissible variants of the virus. Over 40 countries have committed to provide India urgently-required medical supplies like oxygen-related equipment and critical medicines to help it deal with the second wave. 

The Economist reminds us that the Modi government “squandered a lull in infections over the winter, a common criticism runs, and is now flailing in the face of the inevitable resurgence. But while there is no shortage of hapless officials, there is also an impressive supply of ordinary citizens, charities, private companies and even the odd public servant taking their own initiatives to mitigate the crisis”. ITV documents how doctors are left to comfort dying coronavirus patients in India, and feel “helpless”.

Former attorney general of India Soli Sorabjee has died at 91, while being treated for Covid-19. Ashok Amrohi, former Indian ambassador to Brunei, Mozambique and Algeria, passed away after midnight on April 27 while waiting for a bed in the parking lot of Gurgaon’s Medanta hospital for nearly five hours. His passing was condoled by Foreign Minister S Jaishankar, without acknowledging the real cause of death.     BJP spokesperson Narendra Taneja has told CNN’s Christiane Amanpour, “We are the government in India, so of course responsibility is first and foremost ours…” However, he denied that the second wave could have been foreseen. One step forward, one step sideways. 

Andhra Pradesh Chief Minister YS Jagan Mohan Reddy has said that vaccination for people between 18 and 45 years is expected to start only in September, after the cohort over 45 years is dealt with. He is the first chief minister to speak about a credible timeline. Other states like Punjab and Telangana have also made it clear that vaccination of people 18 and up is unlikely to begin soon.

Former prime minister Manmohan Singh has been discharged from the All India Institute of Medical Sciences in New Delhi. RJD president Lalu Prasad Yadav was released from jail yesterday evening on bail by the special CBI court in Ranchi. He will, however, stay on in AIIMS for treatment, as desired by his family.


Supreme Court asks questions, suggests remedies like generics

Two important messages came from the Supreme Court as they heard the suo motu matter of Covid-19 related issues. One, on public expression of grievances of citizens, “If citizens communicate their grievances on social media and internet, then it cannot be said that it’s wrong information,” observed Justice DY Chandrachud. The court warned that it would initiate contempt proceedings against officers penalising such information-sharing. This is a setback to the Centre and the UP government, which were either filing FIRs or threatening to do so against those seeking help publicly. Second, the court has asked The Centre tough questions and suggested a national immunisation policy, in which the Centre procures the vaccines, even if states administer them. The apex court asked, “Why should the Court not issue directions under Section 100 and Section 92 to enable generics to manufacture these drugs without fear of legal action?” The Bench also called for suspension of “political bickering at a time of crisis in Delhi” between the Centre and the states. The hearing continues.


In India, even the pandemic is taxed

There is 12% IGST on Covid aid from abroad. Only the Red Cross is exempted, though it cannot  handle the volume on its own. And there is 12% GST on medical oxygen, 5% on Covid vaccines, 28% on ambulance, twin GST on PPE ― 5% for kits below Rs 1,000 and 12% for the rest, and 12%, 5%, 12% 18% GST on test kits, masks, ventilators and sanitisers respectively. A petition in the Supreme Court seeks exemption, since it would never occur to the government to waive taxes.


China and Russia send aid

Chinese Foreign Minister Wang Yi has written to Jaishankar saying that his country “shares empathy for the challenges facing India and expresses sincere sympathy.” He also wrote that Chinese inputs for fighting the pandemic are entering India at a faster pace. The Chinese ambassador to India adds, “Since this April, China has supplied more than 5,000 ventilators, 21,569 oxygen generators, over 21.48 million masks and around 3,800 tons of medicines to India.” On the Ladakh crisis, the Chinese Defence Ministry spokesperson again said that “the responsibility didn’t lie on Chinese side for the related situation in the west section of China-India border, and India’s related statements claiming China attempted to change the status quo is completely inconsistent with facts.” China has appointed Lieutenant General Wang Kai  as its new commander in the Tibet military region. He is from an army group with decades of fighting experience.

Russia yesterday delivered to India 20 tonnes of medical supplies, mainly oxygen concentrators, ventilators and medicines. The medical supplies were brought to Delhi in two transport aircraft operated by Russia’s EMERCOM, a state-run agency overseeing civil emergency services. 


High Courts question Centre, seek answers

Chief Justice of the Madras High Court Sanjib Banerjee yesterday wondered what the Centre was doing for the last 12 to 14 months without anticipating and preparing for the second wave of the pandemic. Referring to desperate measures being taken now, he said ad hocism can’t fight a pandemic. Solicitor General Tushar Mehta asked the Delhi High Court not to get into pan-India allocation of oxygen or “comparison”, as it would “create panic”. The Division Bench of Justices Vipin Sanghi and Rekha Palli remarked that the panic was not on account of what was being said in court, but what was happening on the ground: “If you have confidence in your responses, have the confidence to place it on record.” While clarifying that it was not seeking more oxygen for the national capital at the cost of other states, the Delhi High Court asked the central government to explain how Madhya Pradesh and Maharashtra were getting more than their demand. 

The Gujarat High Court said in an order that instead of helping patients in crisis, the state government was creating further complications by not giving accurate data. It also directed that all patients who reach hospitals be attended to, irrespective of whether they come in 108 ambulances or private vehicles. After terming the Bihar government’s action plan to tackle the second wave of Covid-19 “wrong”, the Patna High Court yesterday issued an email ID for people to directly submit their complaints about the lack of oxygen supply to it. This is the first direct intervention by a court to ensure supply of oxygen for Covid-19 patients in public as well as private hospitals.

The Aurangabad Bench of the Bombay High Court took strong exception to a press conference held by the Ahmednagar District Collector to support BJP MP Sujay Vikhe Patil in relation to his alleged unauthorised procurement and distribution of Remdesivir. The bench then directed the District Superintendent of Police, Ahmednagar, to trace the boxes of Remdesivir injections unloaded by the MP at Shirdi Airport, and report on May 3. 


Have O2, also have “lowest” death rate: Health Minister

In comments that evoked derision, disbelief, disquiet and suffocation, Union Health Minister Harsh Vardhan maintained that “oxygen was available in adequate quantities earlier also”. That sounded so like we had the Pushpak Vimana before Boeing, so he was panned. In fact, there was not enough oxygen because the Centre had exported record amounts, up 734% between January 2020 and January 2021, and tenders to import oxygen went out in late April. His other major argument was that India had the lowest case fatality rate! With a population of 1.3 billion, surely that cannot be a source of comfort. He should try telling that to the thousands of bereaved. The reception would be extraordinary.


The Long Cable

Fighting a pandemic in an Atmanirbhar ‘electoral autocracy’

Dinesh Thakur

As the second wave of the Covid pandemic wreaks havoc across India, claiming the lives of so many, often breaking the spirit of their loved ones who have been reduced to begging for hospital beds, medicine and oxygen cylinders, it is time to discuss all that went wrong with the Indian government’s response.

In an ideal world, India’s public health strategy should have had the following components: intensive sequencing of the genome of virus samples, cogent public health messaging and triaging those infected as a means to ration scarce public health resources, followed up by transparent drug approval processes based on scientific evidence and swift vaccine procurement policies. Most of these activities were the responsibility of the central government. It has failed on most counts, spectacularly due to a combination of Atmanirbhar policies, systemic defects that have been ignored for far too long despite repeated warnings, and the failure to learn from the rest of the world.

Let’s begin with understanding whether we had an early warning system to tell us that things are beginning to go wrong. A few months ago, it had become very clear that the virus was mutating in Brazil and UK, causing it to spread much faster in those countries. One way to track the type of virus floating around in India is to systematically sample and sequence the genome of samples collected from those who test positive from different parts of the country. The disproportionate presence of fast-spreading mutant varieties in the tested samples can act as an early warning system for the administration on what to expect. For gene-sequencing, the central government put together the Indian SAR-COV-2 Genomics Consortium (INSACOG). As reported by Priyanka Pulla, this consortium was hobbled by Atmanirbhar policies that prevented the procurement of crucial components like reagents and specialised plastic containers, and by failing to communicate to the state governments the utmost importance of ensuring samples were regularly sent to INSACOG labs. Perhaps if 5% of positive samples across states were tested, as was the original aim, we would have had early warnings of the new mutant strains that have caused havoc across the country, especially in Delhi.

Another spectacular failure of the administration has been not to heed its own disease models. As far back as late February, we knew that the virus was spreading in the country (R >1). No public health measures were instituted despite such a clear signal; on the contrary, public health interventions like mask-wearing and social distancing were thrown to the winds in the interest of appeasement to the religious base, and to perverse political objectives.

The second important public health strategy during a pandemic, and one that has been repeated ad nauseam, is the importance of public health messaging by the political leadership. The US provides a glaring example, prior to January, with Donald Trump as its President, and post the inauguration with Joe Biden. The acceptability of interventions such as masks and distancing is often a reflection of the leadership of the country.  This is perhaps the single most important component of a failed public health strategy. In the case of this pandemic, encouraging the Kumbh Mela, holding large election rallies, and the election itself in multiple phases were clear abdications of its responsibility by the administration. Mass gatherings at cricketing stadiums, political rallies and religious events organised by the government sent out a loud message to the common man that he need not worry about the pandemic anymore. The situation in India would likely have been very different now if the government had been more consistent on its public health messaging and the effectiveness of measures.

The third issue pertains to the appalling lack of policies in place to deal with a surge in infections. The standard response in scenarios where the health system is expected to be overwhelmed, based on the projections of disease models, is to create a triaging system where a centralized system of doctors decides whether patients need to be admitted to an ICU, or a bed at a field hospital with or without oxygen support. This saves patients and their relatives the trauma of having to go from hospital to hospital, begging for admission. The most heart-breaking images of this pandemic have been those of relatives of patients dragging them across the city and begging for admission at hospitals. What boggles the mind is the utter apathy of the political class, which is often so sensitive to such optics. A triaging system could have easily eliminated such needless misery and ensured better use of limited resources. Some cities like Mumbai and Chennai appear to have installed a fairly effective triage system, and the results are visible. You don’t see heartbreaking images from Mumbai as often as you see them from Delhi, Kanpur, Lucknow etc. Why then did Delhi and cities in UP fail so miserably on this count?

The fourth issue pertains to the equally heartbreaking issue of relatives of patients begging for medicines like Remdesivir, Favipiravir, Itolizumab and blood plasma. Thankfully, Ramdev’s Coronil did not make it to the list; no thanks to the Union Health Minister who took it upon himself to promote such quackery publicly. There is overwhelming scientific evidence that blood plasma does not work – several clinical trials have made that clear. The government should have made this clear while messaging to the public on the efficacy of various treatments – it would have saved several people needless guilt and shame over being unable to secure plasma for their loved ones. Doctors are unable or unwilling to convince patients on this issue because there has not been any effective communication from the administration. Similarly, Favipiravir should never even have been approved by the Drug Controller General of India (DCGI). The clinical trials conducted in India to establish the efficacy of the drug in Covid treatment are not convincing. Neither the US nor the EU have included it in its treatment protocols. It’s the same for Itolizumab. The clinical trials on the basis of which the approval was granted were not convincing. The issue of shady drug approvals by the DCGI is an old one. Even the Parliamentary Standing Committee on Health flagged this issue in a scathing report in 2012. The Ministry of Health has had plenty of time to fix it, but things have gotten worse since Modi’s Atmanirbhar policies signalled to the bureaucracy to prefer Indian medicines and vaccines over foreign ones. Hence the absurd scenario where Bharat Biotech’s vaccine got approval without any Phase 3 data while foreign  vaccines with reams of Phase 3 data were being asked to jump through hoops and conduct bridging trials to secure permission to sell in India. The resulting and justified outcry over the approval granted to Bharat Biotech almost certainly led to much of the vaccine hesitancy in India, and the DCGI is to blame.  

The fifth and the last catastrophic policy decision that has led to this chaotic second wave was the inability of the central government to put in place a coherent vaccine procurement policy. Last summer, when Western governments were placing bets on vaccines under development by making advance payments to manufacturers, India did nothing until January 2021. It exported vaccines instead. Surprisingly no one in the Indian media asked any questions about the lack of strategy until it was too late. Imagine how different it would have been if we had vaccinated at least half the population of major cities like Delhi and Mumbai.    

Most Indians may have forgiven mistakes made in the first wave. They will not be as forgiving about the blunders that have marked the second wave. There will be plenty of blood on the hands of Indian policymakers after this wave ends. Pain caused to patients and their relatives could easily have been reduced if not avoided entirely if and only if we had a competent and compassionate administration. The lack of planning, the unwillingness of senior politicians and bureaucrats to speak up, the incompetence on display by the scientific establishment, are at levels never before seen in India’s history. The dear leader does not want to hear bad news, and the entire establishment simply fell in line.

As of today, even after all these deaths and pain, not a single member of the Indian government has expressed remorse, or apologized or resigned.

That is perhaps the surest guarantee that we live in an ‘electoral autocracy’.

(Dinesh Thakur is a public health activist)


Reportedly

Rahul Gandhi was right. So say the G-23, the group of epistolary dissidents who had reared their heads some weeks ago in a letter to their leaders, gunning for former Congress party president Rahul Gandhi. His constructive suggestions on vaccine distribution, reduction in the age of immunisation, fast-tracking of emergency approval for foreign-produced shots etc., which were eventually announced by the Modi government, seems to have enhanced the young Gandhi’s stature within the Congress parivar. Dissidents that journalists contacted spoke of his “foresight and vision” and others said that the crisis has “shown Rahul Gandhi’s leadership skills”, signalling a significant shift in internal party dynamics.


Ambani, Adani hide in Gujarat

Reuters reports that India’s two richest have moved to homes in less-populated parts of the country as the virus hits the capital New Delhi and financial hub Mumbai particularly hard. Mukesh Ambani, Asia’s wealthiest man, has shifted from Mumbai’s Antilia with his family to Jamnagar in Gujarat, home to Reliance Industries’ massive twin oil refinery complex. Billionaire Gautam Adani, the second-richest person in India, is with his son Karan Adani and other close family members at their home on the outskirts of Ahmedabad.


Prime Number: 577
Teachers’ unions in Uttar Pradesh have submitted a list of 577 teachers and support staff who died while on panchayat poll duty to the state election commission (SEC), during the current surge. The unions have requested the Election Commission to postpone the counting day, May 2. 

Opeds you don’t want to miss

  • Shrenik Rao writes in Haaretz that “negligent manslaughter is the only way to describe the Modi government’s abominable, grotesque mismanagement of the coronavirus pandemic.”

  • As stories of oxygen shortages and photos of burning funeral pyres are carried across the world, the culpability of the Modi government becomes ever clearer. From the time the first reports of the virus emerged, our prime minister has consistently ignored the danger signs while focusing on building his own personal brand and image, writes Ram Guha in FT.

  • How India lost the plot. Jawhar Sircar on how when the pandemic broke out last year, showmanship and event management were top priority. Essential tasks like factoring in expert advice were considered less glamorous.


Listen up

To explain what is driving this new second wave of the virus in India and the global health implications of the surge, Anup Malani, Lee and Brena Freeman, professor at the University of Chicago Law School and a professor at the Pritzker School of Medicine, talks to Milan Vaishnav on this podcast.


Watch Out

CNN’s Sam Kiley reports from a crematorium in Delhi. 

https://edition.cnn.com/videos/world/2021/04/29/india-covid-crisis-coronavirus-cemetery-delhi-sam-kiley-live-newday-intl-ldn-vpx.cnn


Over and out

India’s first 3D printed house, with a built-up area of 600 square feet, a bedroom, a hall and a kitchen, has been inaugurated at IIT, Madras.

It’s Mayday tomorrow, and the answer is blowin’ in the wind. Hear it from Ishaan.


That’s it for today. We’ll be back with you on Monday, on a device near you. If The India Cable was forwarded to you by a friend (perhaps a common friend!) book your own copy by SUBSCRIBING HERE.